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'Investigate new fees that could hit GP jobs'

The article 'Management of constipation in patients receiving palliative care' (Clinical, July 16) contains the statement: '(Movicol) contains electrolytes that can lead to disordered blood biochemistry when given regularly.'

This implies Movicol is an unsafe product. This statement is untrue and grossly misleading. There is no evidence whatsoever to support this statement and in fact there is good evidence that regular use of Movicol does not cause disordered blood biochemistry.

Gruss and Ulm (2004)1 evaluated blood biochemistry in 544 patients with Parkinson's disease treated over a three-month period with Movicol. And Attar, Lemann et al (1999)2 evaluated blood biochemistry in 50 patients treated with Movicol for four weeks and 65 patients treated for three months.

No changes were seen in either study in mean values during the study and no individual patient deviations from the normal range for any of the laboratory variables was clinically significant.

The SPC for Movicol states: 'Extended use may be necessary in the care of patients with severe chronic or resistant constipation, secondary to multiple sclerosis or Parkinson's disease, or induced by regular constipating medication, in particular opioids and antimuscarinics.'

Therefore Movicol is specifically licensed for just those types of patient that one would see in palliative care with chronic constipation induced by opioids and other constipating medicines.

Dr Mike Geraint

Medical Director

Norgine Ltd

Dr Biswas replies:

Dr Geraint is right; the evidence clearly shows Movicol does not cause disordered blood biochemistry. Movicol is often used very successfully in the palliative care group.